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Current role of chemoembolization in the treatment of HCC

Rafał Kidziński1, Grzegorz Kade1, Krzysztof Pyra2

Abstract

Hepatocellular carcinoma (HCC) accounts for 75% to 85% of primary liver cancers. Recent years have shown a significant increase in the incidence of HCC in Europe and the United States. The algorithm used most commonly in the treatment of HCC is the one developed in 1999 by Barcelona Clinic Liver Cancer (BCLC), updated from clinical trials. The last update is from 2022. Among the available treatments, depending on the stage of HCC, are liver transplantation, resection, thermal ablation, transarterial embolisation (TAE), transarterial chemoembolization (TACE), transarterial radioembolisation (TARE), stereotactic body radiation therapy (SBRT) as well as systemic treatment. The use of irreversible electroporation (IRE), a method involving disruption of cell membrane integrity is currently undergoing research. According to the BCLC, TACE is recommended for patients with BCLC stage-B (more than three lesions, preserved portal vein flow, preserved Child-Pugh A-B liver function and no extrahepatic lesions) and with BCLC stage 0 and stage 1 as an option after failure or not feasible for the first treatment option. In this article, we will try to explain in more detail what the chemoembolization method is and what the indications for its implementation are.

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